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Academic Medicine:
doi: 10.1097/ACM.0b013e3182a7f82f
Responses to the 2013 Question of the Year

Working as a Team to Improve Patient Care in the Intensive Care Unit

Watson, Nicholas C. MD; Isenberger, Johnny L. RN, MSN, ACNP-BC, CCRN

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Author Information

Dr. Watson is clinical assistant professor, Michigan State University College of Human Medicine, and staff anesthesiologist and intensivist, Anesthesia Medical Consultants and Spectrum Health, Grand Rapids, Michigan.

Mr. Isenberger is clinical instructor, University of Massachusetts Medical School Graduate School of Nursing, and advanced care nurse practitioner, UMass Memorial Medical Center, Worcester, Massachusetts.

Correspondence should be addressed to Dr. Watson, Anesthesia Medical Consultants, 3333 Evergreen Dr. NE, Grand Rapids, MI 49525; telephone: (616) 364-4200; e-mail: Nicholas.watson1@gmail.com.

Doctors and nurses share the same goals for patient care. We are at our best when we function as a part of a multidisciplinary team, with individual team members contributing the perspectives and expertise afforded by their professions. Here, we share our perspectives on what a doctor is and what a nurse is, based on our respective experiences as a critical care physician and an acute care nurse practitioner.

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A Physician’s Perspective (N.C.W.)

When I staff the intensive care unit (ICU), I am referred to as “the doctor.” However, my job in this setting is far from the traditional doctor’s role of making a plan and expecting a nurse to execute it. The literature indicates that my work as an intensivist improves patient outcomes in the ICU.1 At the same time, the literature (and my experience) shows that the best outcomes in the ICU result from the efforts of multidisciplinary teams.2 As a critical care physician, I function within an intricate machine designed to care for complicated patients in the increasingly complex world that is modern health care. This type of care relies on the expertise of pharmacists, social workers, nutritionists, technicians, phlebotomists, physician assistants, advanced practice nurses, bedside nurses, physical therapists, occupational therapists, speech-language pathologists, lawyers, ethicists, and an array of consultation physicians, just to identify some of the professions involved. The collective training and experience of the team far exceeds my personal capacity, discrediting the traditional notion of the physician’s unwavering authority. It begs the question “Do we still need doctors?” as Lantos3 so aptly asked.

At the same time, the customary hierarchical structure in which the doctor is “in charge” continues to be relevant. I must evaluate the contributions of team members and integrate key portions of their input into my final assessment and patient care plan. This collaboration allows me to concentrate my energy and time on improving many elements of my practice, especially my position as a team leader. Further, in my role as an educator, I invest time teaching team members; they reciprocate by providing new ideas for patient care. Through collaboration, the multidisciplinary team approach improves the knowledge and skills of all team members. More important, patients benefit from the broad range of expertise. As a multidisciplinary team leader, the doctor is instrumental in marshalling the team’s incredible potential for healing and focusing it on the patient.

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A Nurse’s Perspective (J.L.I.)

As an acute care nurse practitioner in a surgical ICU, I am part of a multidisciplinary team of experts. During a typical workday, I function as a clinician, a scientist, and an educator. As a clinician, I am expected to know the current best evidence for any particular disease process, translate that knowledge into a care plan, communicate with the ICU team, and then collaborate with other disciplines to ensure that the plan is executed. I differ from the physicians I work with because my nursing background provides me with insight that helps me develop creative ideas for addressing the complexities that may exist in trying to accomplish our goals (e.g., identifying the potential risks of traveling off the ICU for imaging, selecting the proper nasogastric tube size to avoid obstruction by crushed medications).

As a scientist, I belong to a team of researchers utilizing our ICU patient population to answer pointed clinical questions. The research team relies on me to identify and solve bedside barriers to the execution of interventions and to data collection. As an educator, I serve as the repository of local ICU knowledge because I work exclusively in critical care. In contrast, physicians split time between the ICU and their primary specialty, and residents rotate for one month at a time. Instructing others in bedside ultrasonography, vascular access procedures, and the details of our critical care electronic medical record are routine parts of my day. Thus, the nurse is an active member of the health care team and provides expertise in many different roles.

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Conclusion

In conclusion, doctors and nurses are experts in their respective fields. Individually, we contribute our backgrounds and experiences; collectively, we work in multidisciplinary teams to provide optimal care for our patients.

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References

1. Pronovost PJ, Angus DC, Dorman T, Robinson KA, Dremsizov TT, Young TL. Physician staffing patterns and clinical outcomes in critically ill patients: A systematic review. JAMA. 2002;288:2151–2162

2. Kim MM, Barnato AE, Angus DC, Fleisher LA, Fleisher LF, Kahn JM. The effect of multidisciplinary care teams on intensive care unit mortality. Arch Intern Med. 2010;170:369–376

3. Lantos JD Do We Still Need Doctors?. 1997 New York, NY Routledge

© 2013 by the Association of American Medical Colleges

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